Application Agreement Authorization, Release and Waiver
I am familiar with the NCSY standards of conduct (www.ncsy.org/standards) and I agree to scrupulously uphold these standards throughout my participation on the program.
I understand that this program is conducted in consonance with NCSY’s religious and educational standards. As such, I agree to adhere to the standards of the program and behave in a manner reflecting positively upon NCSY and my family.
I am aware and I agree that I will be held responsible for any damage to public or private property that NCSY states I caused as a program participant and I agree to fully reimburse all parties involved. I acknowledge that I may never use or be in the possession of illegal substances or materials during this program.
I further understand and agree that acceptance to this and all NCSY programs is contingent upon a successful interview and a completed copy of NCSY’s applicable health history form. Additionally, I understand and agree that I must submit a completed copy of NCSY’s applicable medical form and a copy of my medical insurance card before tickets or bus passes are issued.
I understand and agree that all decisions regarding acceptance to this program are at the sole discretion of the Director of the program.
NCSY/ORTHODOX UNION MEDIA RELEASE
- I hereby authorize The Union of Orthodox Jewish Congregations of America, NCSY, and its affiliates, employees and agents, (together, the “Orthodox Union” or the “OU”) to take photographs and/or video of me when I participate at NCSY or Orthodox Union programs or events. I grant the Orthodox Union full rights to use and share the images resulting from the photographs and/or videos and any reproductions thereof (the “Recording”), in whole or in part, and my biographical information and quotations for any purpose including fundraising, publicity, advertising, or on social media, all without further obligation or compensation. I hereby waive any right of review or approval regarding the Recording and the Orthodox Union shall have the right to edit or delete the Recording in its sole discretion. I understand that all rights in and to the Recording shall be the Orthodox Union’s sole and absolute property. I release and forever discharge the Orthodox Union from all causes of action, suits, or liability of any kind arising from or in connection with the use or publication of any recording of me made in connection with my participation in Orthodox Union events. I waive any right of privacy associated with the Recording and I waive any right to compensation related to the use of the Recording.
- I HAVE READ THIS AGREEMENT AND AM FULLY AWARE OF ITS CONTENTS, INCLUDING THE RELEASE THAT I HAVE AGREED TO HEREIN.
I am entering this agreement on behalf of myself and understand this agreement is binding. I have read this release and I fully understand its contents.
Authorization: I acknowledge and am willing to assume and accept any risks associated with my participation in any aspect of this program, and I agree that the terms of this waiver will likewise bind me, my heirs, legal representatives, and assignees. Without limiting any other release or indemnity contained in this document, I release and will defend, indemnify, and hold harmless NCSY, the Orthodox Union, and their current or former respective officers, directors, trustees, affiliates, agents, employees, independent contractors, consultants, advisors, vendors, volunteers, licensees and assignees (collectively “Releasees” and each a “Releaseefrom and against every Liability, that I or such heirs, legal representatives or assignees or any third party may allege against the Releasees as a direct or indirect result of my participation in this program, including, without limitation, harm to me while on this program.
I have read this release and waiver and I fully understand its contents. In consideration of my acceptance into this program for which I have applied, I do hereby agree to the seven items listed below:
1. Compliance: I shall comply with all rules, regulations and standards of conduct fixed by NCSY, its agents and employees. I acknowledge and understand that the director has the right to terminate my participation if they deem it necessary for the best interest of the program. In the unlikely event of such termination, I understand that no refunds will be issued, and that I am responsible for my own travel arrangements. In the event I decide to terminate my participation prior to the program’s conclusion, I will assume all responsibility to coordinate travel arrangements to return home. In either of these cases, I understand that any and all expenses associated with the termination will be my sole responsibility and no refunds will be issued.
2. Cancellation and Withdrawal:
No refunds will be given unless the OU and NCSY cancel the trip. We highly encourage everyone to purchase their own travel insurance.
- Medical: I hereby affirm that I have been or will be examined by a qualified licensed physician in compliance with this registration process. Said physician is in possession of all pertinent facts concerning me and the program for which I am applying. As will be confirmed by the Physician’s Statement that will be sent to NCSY subsequently, I am in good health, may travel as required, and am free from any physical, psychological, or emotional disability or weakness which might endanger or negatively impact upon my experience or the experience of those with whom I travel. .
Should it appear to the director that I am suffering from any condition – physical, psychological, or emotional- that could negatively impact upon my experience or the experience of those with whom I travel, then, I may, at the sole and absolute discretion of NCSY or its representatives, be returned home at my sole expense, and there shall be no refund of money paid for the program.
I further understand that, in the event of an illness or injury requiring treatment for me, the Program Director will make reasonable attempts to contact my emergency contact before treatment is administered where practically possible, unless the illness/injury is of such minor extent that only minimum first aid treatment or non-prescription medication (e.g. Tylenol, Advil, Kaopectate, Antihistamine, etc.) is required. Though NCSY is not required to provide such treatment, I hereby authorize the Program Director to make such decisions. In this spirit, I will complete all medical-related forms and advise NCSY of any medications (over the counter or otherwise) which may not be administered.
In the event that my emergency contact cannot be reached in a reasonable amount of time using reasonable diligence, I authorize the Program Director to obtain from the local medical clinic or district hospital, or to provide on site, the necessary medical attention for my complete health and such treatment as described above. I also give permission to the physician or EMT selected by NCSY to hospitalize, secure proper treatment for, and to order injection, anesthesia, or surgery for me if I am unable to give guidance or direction. I agree to reimburse immediately and/or accept financial responsibility for the total cost of all medical care provided to me.
By checking below, I release said medical personnel, NCSY and the OU, their respective officers, directors, trustees, affiliates, agents, employees, independent contractors, consultants, advisors, vendors, volunteers, licensees and assignees (collectively “Releasees” referred to herein and each a “Releasee”) from and against every claim, loss, damage and liability or responsibility, including, without limitation, reasonable attorneys’ fees and costs (“Liabilities”) arising from any judgments or decisions made in the obtaining and rendering of medical assistance and treatment.
As a condition of acceptance, I agree to submit without delay a form filled out by my physician attesting to my suitability for this program.
4. Permission to use Contact Information: I hereby permit my name and contact information to be shared with other program participants and prospective participants, third party Jewish organizations and other OU programs so that any of them may contact me regarding events that may interest me or my child.
- Travel Awareness:
I affirm my understanding of the risks associated with international travel. By checking the box located below, I affirm for myself and on behalf of my family, next of kin, heirs and representatives, that we shall make no claim against NCSY, the OU, their officers, trustees, agents, employees, independent contractors, program suppliers, hotel, common carrier, travel agency, licensees and assignees, for any damage, injury, death, loss or expense resulting from my overseas travel in connection with this program.
I further understand that NCSY and the OU shall, in no way, be deemed responsible for the operation or management of any means of transportation, public or private, or facilities used or enjoyed during the program. Additionally, any claim which may accrue to me against the airline carrier providing transportation between the country of origin and Israel and/or Europe and return will be limited by the Convention of Warsaw of October 12, 1929, as amended, and any other applicable domestic international laws or treaties, the terms of the Charter Agreement with the applicable airline carrier(s), and published tariff regulations.
7. Israel Travel Considerations By registering and/or participating in all or part of any trips or activities organized by the OU, including any travel to, from and within Poland, I agree to the following:
I acknowledge that I have been advised by OU of the issuance of a Travel Warning by the United States Department of State available here: https://travel.state.gov/content/travel/en/traveladvisories/traveladvisories/poland-travel-advisory.html
I understand and agree that none of NCSY, the OU, their officers, trustees, agents, employees, independent contractors, program suppliers, hotel, common carrier, travel agency, licensees and assignees, shall be responsible or liable, and I, for myself and on behalf of my family, next of kin, heirs and representatives, shall make no claim against them or their officers, trustees, agents, employees, independent contractors, program suppliers, hotel, common carrier, travel agency, licensees and assignees, for any damages, injury, death, loss or expense resulting from travel or in connection with my participation in this program.